Chapter 14: Neurocognitive Disorders and Disorders Related to Aging

Question 1

What influences the development of a neurocognitive disorder?

Answer 1

Arise when the brain is either damaged or impaired in its ability to function due to:

• Injury
• Illness
• Exposure to toxins
• Use or abuse of psychoactive drugs

Question 2

Why are neurocognitive disorders considered to be biologically based although psychological and environmental factors can also be key factors?

Answer 2

Neurocognitive disorders are biologically based

Psychological and environmental factors play key roles in determining impact and range of disabling symptoms.

However, they are classified as biologically based due to evidence of a functional decline in parts of the brain.

Question 3

Delirium

Answer 3

A state of extreme mental confusion in which people have difficulty focusing their attention, speaking clearly and coherently, and orienting themselves to the environment.

• Disturbances in perception.
• Dramatic slowing of movement.
• Fluctuations between restlessness and stupor.

Question 4

Major neurocognitive disorder

Answer 4

A profound decline or deterioration in mental functioning characterized by significant impairment of memory, thinking processes, attention, judgment, and by specific cognitive deficits.

Major neurocognitive disorder - Dementia

• Most frequent cause is Alzheimer’s disease (AD).
• Usually follows a progressive and irreversible course.
• Typically occurs in people over the age of 80.
• Late-onset dementia – after age 65.
• Early-onset dementia – 65 or earlier.

Question 5

Mild neurocognitive disorder

Answer 5

Applies to people who suffer a mild or modest decline in cognitive functioning from their prior level.

Able to function independently and complete everyday tasks at home and on the job.

Question 6

Alzheimer’s disease

Answer 6

A degenerative brain disease that leads to progressive and irreversible dementia, characterized by memory loss and deterioration of other cognitive functions, including judgment and ability to reason.

Risk increases dramatically with advancing age

Expected to affect approximately 15 million people by the year 2050

Question 7

What are the features related to mild, moderate, and severe Alzheimer’s Disease?

Answer 7

Early stages of the disease
- Limited memory problems and subtle personality changes

Moderately severe Alzheimer’s Disease
- Require assistance in managing every day tasks.

Advanced stage may include:

• Talking to self
• Visual hallucinations
• Paranoid delusions

Question 8

What do we know about what generally causes Alzheimer’s?

Answer 8

Cause is generally considered unknown.

Possible contributing factors:

• Formation of plaques and tangled nerve fibers in the brain.
• Genetic variant - ApoE4 gene
• Environmental factors

Question 9

What are the noted treatment approaches, do any significantly alter the course of Alzheimer’s?

Answer 9

Drug treatment
- Provides modest benefits in slowing cognitive decline and boosting cognitive functioning.

Cognitive activities
- Help boost cognitive performance in people with mild to moderate AD.

Lifestyle factors
- Regular exercise program and following a healthy diet may reduce risk.

Question 10

What typically causes vascular neurocognitive disorder, and what is the immediate effect to the brain?

Answer 10

A form of major or mild neurocognitive disorder resulting from cerebrovascular events (strokes) affecting the brain.

Cerebrovascular accident (CVA)
- A stroke or brain damage resulting in a disruption in blood supply.

Question 11

Symptoms of vascular neurocognitive disorder

Answer 11

Symptoms:

• Impaired memory and language ability
• Agitation
• Emotional instability
• Unable to attend to basic needs

Question 12

What parts of the brain are associated with frontotemporal neurocognitive disorder?

Answer 12

A disorder characterized by the deterioration of brain tissue in the frontal and temporal lobes of the cerebral cortex

Question 13

When is the usual onset of frontotemporal neurocognitive disorder?

Answer 13

Usually begins in middle age

Risk declines with age after 70

Question 14

What is the likely result of neurocognitive disorder due to traumatic brain injury, does it usually entail a single or multiple events?

Answer 14

Head trauma results from:

• Jarring
• Banging
• Cutting brain tissue from injury or assault

More likely to result from multiple head traumas than from a single blow.

Can cause progressive dementia

Question 15

What substance is typically associated with Korsakoff’s Syndrome?

Answer 15

Syndrome associated with chronic alcoholism, characterized by irreversible memory loss due to brain damage, resulting from deficiency of vitamin B1 (thiamine)

Question 16

What tends to occur for patients with Korsakoff’s syndrome as it progresses?

Answer 16

Can become grossly disoriented and confused, and require custodial care

Question 17

What are some of the common physical and psychological features of Parkinson’s?

Answer 17

Progressive disease characterized by uncontrollable shaking or tremors, rigidity, disturbances in posture, and lack of control over body movements.

In some cases, cognitive impairment.

Question 18

What other neurocognitive disorder simultaneously occurs with Parkinson’s?

Answer 18

Dementia occurs in about 80% of cases diagnosed with Parkinson’s.

Question 19

What is the identified cause of Huntington’s disease?

Answer 19

Caused by a genetic defect on a single gene

Question 20

Features of Huntington’s disease

Answer 20

Take note that the described features sound similar to Parkinson’s but are in effect different and more severe.

Most prominent physical symptoms are involuntary, jerky movements of the face (grimaces), neck, limbs, and trunk.

Question 21

Describe the features of neurocognitive disorder due to HIV infection and identify the other neurocognitive disorder associated with this disorder once HIV progresses to AIDS.

Answer 21

HIV, which causes AIDS, can invade the central nervous system and cause a minor or major neurocognitive disorder.

Major cognitive effects include forgetfulness, impaired concentration, and problem-solving ability.

Dementia is rare in persons who have not yet developed full-blown AIDS.

Common behavioral features are apathy and social withdrawal.

As AIDS progresses, dementia grows more severe.

Question 22

Anxiety in adults

Answer 22

Anxiety disorders are the most commonly occurring psychological disorder among older adults, even more common than depression.

Upwards of 14 percent of older adults suffer from a diagnosable anxiety disorder.

Question 23

Depression in adults

Answer 23

A common problem affecting many older adults, especially those with a prior history of depression.

Approximately 1% to 5% of older adults are currently suffering from a diagnosable major depressive episode.

Question 24

Sleep problems in adults

Answer 24

Sleep problems, especially insomnia, are common among older people.

Upward of 50% of older adults report sleep problems.

Often linked to depression, dementia, and anxiety disorders, as well as medical illness.

Question 25

Identify the psychosocial factors related to insomnia/sleep issues for older adults

Answer 25

Psychosocial factors, such as loneliness and the related difficulty of sleeping alone after the loss of a spouse, also implicated in many cases

Question 26

What is the recommended with regard to sleep medications?

Answer 26

Sleep medications used, but should only be temporary since they can cause side effects and lead to dependence.